|Publication number||US8109962 B2|
|Application number||US 11/455,421|
|Publication date||Feb 7, 2012|
|Filing date||Jun 19, 2006|
|Priority date||Jun 20, 2005|
|Also published as||US8845677, US20060287701, US20120095543|
|Publication number||11455421, 455421, US 8109962 B2, US 8109962B2, US-B2-8109962, US8109962 B2, US8109962B2|
|Original Assignee||Cook Medical Technologies Llc|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (102), Referenced by (4), Classifications (18), Legal Events (3)|
|External Links: USPTO, USPTO Assignment, Espacenet|
This application claims the benefit of U.S. Provisional Application No. 60/692,317, filed on Jun. 20, 2005, entitled “Retrievable Device Having A Reticulation Portion With Staggered Struts,” the entire contents of which are incorporated herein by reference.
The present invention relates to medical devices. More particularly, the present invention relates to retrievable devices, methods for treating a stenotic lesion in a body vessel, and methods for capturing emboli during treatment of a stenotic lesion within a body vessel.
Treatments for a stenotic lesion are continuously being improved. One example is the treatment for carotid artery stenosis. Generally, carotid artery stenosis is the narrowing of the carotid arteries, the main arteries in the neck that supply blood to the brain. Carotid artery stenosis (also called carotid artery disease) is a relatively high risk factor for ischemic stroke. The narrowing is usually caused by plaque build-up in the carotid artery. Plaque forms when cholesterol, fat and other substances form in the inner lining of an artery. This formation process is called atherosclerosis.
Depending on the degree of stenosis and the patient's overall condition, carotid artery stenosis has been treated with surgery. The procedure (with its inherent risks) is called carotid endarterectomy, which removes the plaque from the arterial walls. Carotid endarterectomy has proven to benefit patients with arteries substantially narrowed, e.g., by about 70% or more. For people with less narrowed arteries, e.g., less than about 50%, an anti-clotting drug may be prescribed to reduce the risk of ischemic stroke. Examples of these drugs are anti-platelet agents and anticoagulants.
Carotid angioplasty is a more recently developed treatment for carotid artery stenosis. This treatment uses balloons and/or stents to open a narrowed artery. Carotid angioplasty is a procedure that can be performed via a standard percutaneous transfemoral approach with the patient anesthetized using light intravenous sedation. At the stenosis area, an angioplasty balloon is delivered to predilate the stenosis in preparation for stent placement. The balloon is then removed and exchanged via catheter for a stent delivery device. Once in position, a stent is deployed across the stenotic area. If needed, an additional balloon can be placed inside the deployed stent for post-dilation to make sure the struts of the stent are pressed firmly against the inner surface of the vessel wall.
Currently, stents used for treatment of a stenosis are typically permanent devices when deployed in a body vessel. In many situations, when a stenosis condition has passed, the deployed stent can not be removed from the patient.
Thus, there is a need to provide a retrievable device, e.g., a stent, for treatment of a stenosis in a body vessel.
The present invention generally provides a retrievable device for treatment of a stenotic lesion in a body vessel, allowing for removal of the device after a stenosis condition has passed in the body vessel. Embodiments of the present invention provide a device for treating a stenotic lesion of a blood vessel while allowing removal of the device after the stenosis condition has passed.
In one embodiment, the present invention provides a retrievable device for treatment of a stenotic lesion in a body vessel. The device comprises a reticulation portion having a deployed state and a collapsed state. The reticulation portion includes a plurality of struts connected together in a singly staggered configuration distally along a longitudinal axis. The plurality of struts of the reticulation portion is configured to fold along the longitudinal axis defining a collapsed state of the device for retrieval. The device further comprises an expandable body distally extending from the reticulation portion along on outer diameter for treatment of the stenotic lesion. The expandable body is configured to expand in the deployed state and collapsed in the collapsed state of the reticulation portion for retrieval. The device further comprises a retrieval stem extending proximally from the reticulation portion for retrieval of the device in the collapsed state.
In another embodiment, the present invention provides for an angioplasty assembly having a retrievable stent for treating a stenotic lesion in a body vessel. The assembly comprises an outer catheter including a tubular body having a distal end. The assembly further comprises a retrievable stent coaxially disposable within the tubular body of the outer catheter and deployable through the distal end thereof for treatment of the stenotic lesion in the body vessel. In this embodiment, the stent comprises the reticulation portion, the expandable body, and the retrieval stem.
In another example, the present invention provides a method for treating a stenotic lesion in a body vessel. The method comprises providing the retrievable stent deployed from the outer catheter at the stenotic lesion in the body and singly folding each of the struts about each pivotal joint to collapse the reticulation portion in the collapsed state. The method further comprises retracting a stent in the outer catheter to retrieve the stent from the body vessel.
Further objects, features, and advantages of the present invention will become apparent from consideration of the following description and the appended claims when taken in connection with the accompanying drawings.
The present invention generally provides a retrievable device that is removable from a body vessel after a stenosis condition has passed or after treatment of a stenotic lesion. Embodiments of the present invention generally provide a device, e.g., a retrievable stent, comprising a reticulation portion including a plurality of struts connected together in a singly staggered configuration distally along a longitudinal axis. The singly staggered configuration allows for relatively easy retrieval of the device. Moreover, the device comprises an expandable body that distally extends from the reticulation portion along an outer diameter for treatment of the stenotic lesion.
In this embodiment, the reticulation portion 12 extends along an outer diameter 22 when in the expanded state. As shown, the singly staggered configuration 16 of the plurality of struts 14 distally extends from a proximal portion 17 of the reticulation portion 12 along the longitudinal axis A to a distal portion 18 thereof. In the expanded state, each of the struts 14 of the reticulation portion 12 is configured to fold singly in pairs along the longitudinal axis A to the collapsed state. As will be described in greater detail below, the singly staggered configuration 16 allows the device 10 to be relatively easily collapsed and retrieved when deployed at a stenotic area within the vasculature of a patient.
As shown in
The reticulation portion 12 distally extends from the proximal portion 17 to the distal portion 18 along the outer diameter 22. Preferably, the reticulation portion 12 extends substantially constant along the outer diameter 22 when in the expanded state. As shown in
As mentioned above,
As mentioned, the proximal stem 24 extends in alignment with the outer diameter 22 of the reticulation portion 12 relative to a radial axis of the device 10. This allows for more effective filtering and lessens the risk of blood flow issues within the vasculature during angioplasty, while maintaining a relatively easy way for delivery and retrieval. However, the proximal stem 24 may be configured as desired to extend circumferentially within, in non-alignment with, the outer diameter 22 of the device 10.
In this embodiment, the device 10 further includes an expandable body 30 distally extending from the reticulation portion 12 along the outer diameter 22 for treatment of the stenotic lesion. The expandable body 30 is configured to open in the expanded state for angioplasty and close in the collapsed state for delivery and retrieval. The expandable body 30 may be configured in any suitable manner to expand and collapse. For example, the expandable body 30 may comprise a plurality of branches 32 connected together as shown in
The device 10 may be comprised of any suitable material such as a superelastic material, stainless steel wire, cobalt-chromium-nickel-molybdenum-iron alloy, or cobalt-chrome alloy. It is understood that the device 10 may be formed of any other suitable material that will result in a self-opening or self-expanding device 10, such as shape memory material. Shape memory materials or alloys have the desirable property of becoming rigid, i.e., returning to a remembered state, when heated above a transition temperature. A shape memory alloy suitable for the present invention is Ni—Ti available under the more commonly known name Nitinol. When this material is heated above the transition temperature, the material undergoes a phase transformation from martensite to austenic, such that material returns to its remembered state. The transition temperature is dependent on the relative proportions of the alloying elements Ni and Ti and the optional inclusion of alloying additives.
In one embodiment, the device 10 is made from Nitinol with a transition temperature that is slightly below normal body temperature of humans, which is about 98.6° F. Thus, when the device 10 is deployed in a body vessel and exposed to normal body temperature, the alloy of the device 10 will transform to austenite, that is, the remembered state, which for one embodiment of the present invention is the expanded configuration when the device 10 is deployed in the body vessel. To remove the device 10, the device 10 is cooled to transform the material to martensite which is more ductile than austenite, making the device 10 more malleable. As such, the device 10 can be more easily collapsed and pulled into a lumen of a catheter for removal.
In another embodiment, the device 10 is made from Nitinol with a transition temperature that is above normal body temperature of humans, which is about 98.6° F. Thus, when the device 10 is deployed in a body vessel and exposed to normal body temperature, the device 10 is in the martensitic state so that the device 10 is sufficiently ductile to bend or form into a desired shape, which for the present invention is an expanded configuration. To remove the device 10, the device 10 is heated to transform the alloy to austenite so that the device 10 becomes rigid and returns to a remembered state, which for the device 10 in a collapsed configuration.
Generally, the balloon catheter 42 has a proximal end 50, a distal end 52, and a plastic adapter or hub 54 to receive the assembly 40 to be advanced therethrough. The hub 54 is in fluid communication with the balloon for fluid to be passed therethrough for inflation and deflation of the balloon during angioplasty. In one embodiment, the balloon catheter 42 may include an outer lumen and an inner lumen. The outer lumen is preferably in fluid communication with the expandable balloon 46 for inflating and deflating the balloon. The inner lumen is formed therethrough for percutaneous guidance through the body vessel. The balloon catheter 42 is preferably made of a soft, flexible material such as a silicone or any other suitable material.
The size of the expandable balloon 46 may vary. For example, the balloon size may range between about 2 and 10 millimeters in diameter. The expandable balloon 46 has distal and proximal portions 17. The expandable balloon 46 may be made of any suitable material such as low density polymer material such as polyvinyl chloride.
The assembly 40 further includes a wire guide 56 which via an introducer sheath 58 (discussed in greater detail below) is percutaneously inserted to provide a path for the balloon catheter 42 within the vasculature of a patient. The balloon catheter 42 is configured to be disposed about the wire guide 56 for percutaneous guidance through the vasculature. The size of the wire guide 56 is based on the inside diameter of the introducer sheath 58.
As mentioned above, the assembly 40 further includes a polytetrafluoroethylene (PTFE) introducer sheath 58 for percutaneously introducing the wire guide 56 and the balloon catheter 42 in vasculature. Of course, any other suitable material may be used without falling beyond the scope or spirit of the present invention. The introducer sheath 58 is percutaneously inserted into the vasculature of the patient. The sheath 58 may have a size of about 4-French to 8-French and allows the balloon catheter 42 to be inserted therethrough to the deployment location in the body vessel. In one embodiment, the sheath receives the balloon catheter 42 and the device 10, and provides stability thereto at the deployment location.
The assembly 40 may further include an outer catheter 60 disposed co-axially about the balloon catheter 42 within the introducer sheath 58. As shown, the outer catheter 60 is preferably configured to house the balloon catheter 42 and the device 10 during delivery and retrieval thereof to and from the stenotic lesion. The outer catheter 60 is preferably advanced with the balloon catheter 42 and the device 10 to the deployment location. When the distal end 52 of the expandable balloon 46 of the balloon catheter 42 is placed across the stenotic lesion in the body vessel, the expandable balloon 46 may then be inflated preferably with saline. For deployment of the expandable balloon 46 and the device 10, the outer catheter 60 is then retracted to expose the device 10 and angioplasty balloon at the stenotic lesion. The angioplasty balloon is inflated, and both the device 10 and balloon expands to break plaque of the stenotic lesion.
It is to be understood that the assembly described above is merely one example of an assembly that may be used to deploy the capturing device in a body vessel. Of course, other apparatus, assemblies, and systems may be used to deploy any embodiment of the capturing device without falling beyond the scope or spirit of the present invention.
In this example, an outer catheter is used to fold the struts of the retrievable stent to its collapsed state for retrieval. The outer catheter is percutaneously inserted in the vasculature proximally adjacent the location of the stent. The outer catheter is then moved distally to receive the stent starting from the proximal portion thereof. In one example, the retrieval stem is pulled to proximally move the reticulation portion toward the distal end of the outer catheter, receiving the reticulation portion. Alternatively, the outer catheter may be distally moved toward the device to initiate folding of the struts. As the outer catheter longitudinally receives the stent, each pair of the struts is singly folded about each pivotal joint to move the reticulation portion in the collapsed state in box 114.
Once the stent is in its collapsed state, i.e., each pair of struts is folded about its respective pivotal joint, the stent may be retracted. As the outer catheter is proximally retracted to retract and retrieve the stent from the vasculature of the body vessel in box 116.
The retrieval device 210 of this embodiment further includes a filter portion 213 for capturing emboli during treatment of a stentic lesion, e.g., angioplasty.
As shown in
The filter portion may be comprised of any suitable material to be used for capturing emboli from the stenotic lesion during treatment thereof. In one embodiment, the filter portion is made of connective tissue material for capturing emboli. In this embodiment, the connective tissue comprises extracellular matrix (ECM). As known, ECM is a complex structural entity surrounding and supporting cells that are found within mammalian tissues. More specifically, ECM comprises structural proteins (e.g., collagen and elastin), specialized protein (e.g., fibrillin, fibronectin, and laminin), and proteoglycans, a protein core to which are attached are long chains of repeating disaccharide units termed of glycosaminoglycans.
Most preferably, the extracellular matrix is comprised of small intestinal submucosa (SIS). As known, SIS is a resorbable, acellular, naturally occurring tissue matrix composed of ECM proteins and various growth factors. SIS is derived from the porcine jejunum and functions as a remodeling bioscaffold for tissue repair. SIS has characteristics of an ideal tissue engineered biomaterial and can act as a bioscaffold for remodeling of many body tissues including skin, body wall, musculoskeletal structure, urinary bladder, and also supports new blood vessel growth. In many aspects, SIS is used to induce site-specific remodeling of both organs and tissues depending on the site of implantation. In theory, host cells are stimulated to proliferate and differentiate into site-specific connective tissue structures, which have been shown to completely replace the SIS material in time.
In this embodiment, SIS is used to temporarily adhere the filter portion to the walls of a body vessel in which the device is deployed. SIS has a natural adherence or wettability to body fluids and connective cells comprising the connective tissue of a body vessel wall. Due to the temporary nature of the duration in which the device is deployed in the body vessel, host cells of the wall will adhere to the filter portion but not differentiate, allowing for retrieval of the device from the body vessel.
In other embodiments, the filter portion may also be made of a mesh/net cloth, nylon, polymeric material, Teflon™, or woven mixtures thereof without falling beyond the scope or spirit of the present invention.
While the present invention has been described in terms of preferred embodiments, it will be understood, of course, that the invention is not limited thereto since modifications may be made to those skilled in the art, particularly in light of the foregoing teachings.
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|U.S. Classification||606/200, 623/1.11|
|Cooperative Classification||A61F2002/91525, A61F2230/008, A61F2002/91558, A61F2002/9528, A61F2002/91508, A61F2/91, A61F2002/018, A61F2002/91533, A61F2230/0006, A61F2/915, A61F2/013, A61F2230/0076|
|European Classification||A61F2/915, A61F2/01D, A61F2/91|
|Jun 19, 2006||AS||Assignment|
Owner name: COOK INCORPORATED, INDIANA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:PAL, DHARMENDRA;REEL/FRAME:017991/0528
Effective date: 20060615
|Jan 4, 2012||AS||Assignment|
Owner name: COOK MEDICAL TECHNOLOGIES LLC, INDIANA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:COOK INCORPORATED;REEL/FRAME:027474/0739
Effective date: 20111027
|Jul 28, 2015||FPAY||Fee payment|
Year of fee payment: 4